观察桂枝加葛根汤结合温针灸治疗颈性眩晕的临床疗效及对炎性因子IL-6、hs-CRP、血清内皮素-1及NO的影响。

选取2019年1月至2022年4月南京中医药大学连云港附属医院收治的90例颈性眩晕患者，采用随机数字表法分为对照组和观察组各45例。对照组给予甲磺酸倍他司汀片治疗，每次6 mg，每日3次。观察组在对照组基础上增加温针灸及桂枝加葛根汤治疗，温针灸隔日1次，中药汤剂每日1剂。4周后观察2组患者治疗前后颈性眩晕症状与功能评估量表(ESCV)评分、前基底动脉及双侧椎动脉的收缩期峰流速(Vs)和平均血流速度(Vm)、hs-CRP、IL- 6、ET-1、NO的水平。

观察组痊愈16例，显效18例，有效7例，无效2例，总有效率95.35%(41/43)；对照组痊愈12例，显效9例，有效15例，无效8例，总有效率81.81%(36/44)，观察组治疗总有效率明显高于对照组(χ²＝3.914，P<0.05)。与治疗前比较，观察组和对照组治疗后的眩晕、头痛、颈肩痛、日常生活及工作评分均明显升高(观察组：t＝－12.612、－16.809、－12.545、－15.902，P均<0.05；对照组：t＝－10.658、－8.691、－8.174、－11.681，P均<0.05)；与对照组比较，观察组治疗后眩晕、头痛、颈肩痛评分均明显降升高(t＝－2.499、－4.279、－2.198，P均<0.05)。与治疗前比较，观察组治疗后基底动脉及双侧椎动脉的Vs、Vm均明显增快(前基底动脉：t＝－11.875、－63.50，P均<0.05；双侧椎动脉：t＝－37.346、－25.800、－25.699、－24.576，P均<0.05)；与治疗前比较，对照组治疗后基底动脉Vs、Vm均明显增快(t＝－2.815、－10.823，P均<0.05)；与对照组比较，观察组治疗后基底动脉及双侧椎动脉的Vs、Vm均明显增快(基底动脉：t＝－3.022、－6.970，P均<0.05；双侧椎动脉：t＝－8.073、－10.417、－6.356、－5.958，P均<0.05)。与治疗前比较，2组治疗后血清hs-CRP、IL-6、ET-1水平均明显降降低，NO水平均明显升高(观察组：t＝15.549、11.862、18.102、－11.276，P均<0.05；对照组：t＝－8.767、－6.051、－9.565、－8.645，P均<0.05)；与对照组比较，观察组治疗后血清hs-CRP、IL-6、ET-1水平均明显降降低，NO水平明显升高(t＝4.177、3.925、6.110、－4.051，P均<0.05)。

桂枝加葛根汤结合温针灸可有效改善颈性眩晕患者的临床症状，作用机制可能是抑制血清炎症因子hs-CRP、IL-6水平以缓解肌肉紧张，并可增加NO合成及降低ET-1释放，从而改善血管内皮血液供应。

To observe the clinical effect of Gui Zhi Jia Ge Gen Tang combined with warming needle moxibustion on cervical vertigo and its influence on inflammatory factors IL- 6, hs-CRP, ET-1 and NO.

90 patients with cervical vertigo admitted to Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine from January 2019 to April 2022 were included and randomly divided into the control group and observation group with 45 cases each. The control group was treated with betahistine mesylate tablets, 6mg each time, three times a day. On the basis of the basic treatment, the observation group received warming needle moxibustion and Gui Zhi Jia Ge Gen Tang, warming needle moxibustion once every other day, and herbal medicine once a day. After 4 weeks, the cervical vertigo and functional score, systolic peak flow velocity (Vs) and mean blood flow velocity (Vm) levels of the anterior basilar artery and bilateral vertebral arteries, as well as the levels of hs-CRP, IL- 6, ET-1, and NO in two groups of patients before and after treatment were evaluate.

In the observation group, 16 cases were cured, 18 cases were significantly improved, 7 cases were effective, and 2 cases were ineffective, with a total effective rate of 95.35% (41/43); In the control group, 12 cases were cured, 9 cases were significantly improved, 15 cases were effective, and 8 cases were ineffective, with a total effective rate of 81.81% (36/44). The total effective rate of the observation group was significantly higher than that of the control group( χ²=3.914, P<0.05). After treatment, both groups showed significant improvement in dizziness, headache, neck and shoulder pain, daily life and work scores (observation group: t=-12.612, -16.809, -12.545, -15.902, all P<0.05; control group: t=-10.658, -8.691, -8.174, -11.681, all P<0.05); Compared with the control group, the observation group showed a significant increase in dizziness, headache, and neck and shoulder pain scores after treatment (t=-2.499, -4.279, -2.198, all P<0.05). After treatment, the Vs and Vm of the basilar and bilateral vertebral arteries in the observation group increased significantly(anterior basilar artery: t=-11.875, -63.50, P<0.05; bilateral vertebral artery: t=-37.346, -25.800, -25.699, -24.576, P<0.05); After treatment, the basal artery Vs and Vm in the control group increased significantly (t=-2.815, -10.823, all P<0.05). Compared with the control group, the Vs and Vm of the basilar and bilateral vertebral arteries in the observation group increased significantly after treatment (basilar artery: t=-3.022, -6.970, all P<0.05; bilateral vertebral artery: t=-8.073, -10.417, -6.356, -5.958, all P<0.05). After treatment, the levels of serum hs-CRP, IL- 6, and ET-1 in both groups decreased significantly after treatment, while the levels of NO increased significantly (observation group: t=15.549, 11.862, 18.102, -11.276, all P<0.05; control group: t=-8.767, -6.051, -9.565, -8.645, all P<0.05); Compared with the control group, the serum levels of hs-CRP, IL- 6, and ET-1 in the observation group decreased significantly after treatment, while the levels of NO increased significantly (t=4.177, 3.925, 6.110, -4.051, all P<0.05).

Gui Zhi Jia Ge Gen Tang combined with warming needle moxibustion can effectively improve the clinical symptoms of cervical vertigo. The mechanism may be related to decreasing serum inflammatory factors hs-CRP and IL- 6, in order to relieve muscle tension, and increasing NO synthesis, reducing ET release to improve vascular endothelial blood supply.